Rebirth 1977 Great Era

Chapter 1213 Challenge: Elderly Patient with Cirrhosis and Ascites (Bonus Chapter for Monthly Tickets: 3K Chapters)

Fang Yan was completely unaware of the discussion among the three vice deans, but even if he had known, he wouldn't have cared.

He never really wanted the dean position.

His political awareness and methods are no longer suited to this place; there are too many twists and turns here.

Moreover, fighting amongst themselves in a small place is not a sign of aspiring to great things.

By this time, he had already returned to the traditional Chinese medicine clinic with the people who had completed their examinations.

The man in front of me is an elderly comrade, eighty-three years old, surnamed Liu.

Previous examinations showed that he urinated infrequently, felt bloated in his abdomen, had high blood pressure, and was unable to walk on his own most of the time, requiring a wheelchair or assistance.

Today, a Western medicine examination revealed cirrhosis of the liver and moderate to severe ascites, but the patient has not been informed yet.

However, the doctor here was quite familiar with the local Western medicine and dialect. They used to discuss various cutting-edge issues in Western medicine in the cafeteria, so when they met the doctor, they immediately explained the situation to him.

In Western medicine, this is considered a complex condition that is difficult to treat.

Cirrhosis is an end-stage disease resulting from long-term liver damage, in which irreversible fibrosis and nodule formation have occurred in the liver tissue structure, and liver function is severely impaired.

The elderly man's moderate to severe ascites is a typical manifestation of decompensated cirrhosis, which means that the liver's ability to synthesize albumin has decreased, portal hypertension and other problems have become more serious, and there is a large amount of fluid in the abdominal cavity, which may be accompanied by symptoms such as abdominal distension, poor appetite and difficulty breathing.

At 83 years old, the patient belongs to the elderly group, and the functions of various organs, especially the liver, kidneys, and heart, are already in a state of decline. In addition, the patient also has hypertension, so treatment needs to take into account multiple system problems, and the room for adjustment of the treatment plan is relatively limited.

If you can take care of one side, you can't take care of the other.

Furthermore, decompensated cirrhosis can lead to serious complications such as upper gastrointestinal bleeding, hepatic encephalopathy, and spontaneous peritonitis. Elderly patients have a lower tolerance for these complications, which further increases the difficulty and risk of treatment.

Of course, Fang Yan also knew this. For patients in their eighties, the available treatment options were quite limited, and he didn't have many patients in this age group.

Influenced by concepts such as "let nature take its course" and "enjoy your old age," some families believe that when elderly patients are seriously ill, they should focus more on quality of life rather than forcibly intervene. In addition, the treatment of serious illnesses often requires long-term hospitalization, high medical expenses, and special care, which is a heavy burden for ordinary families. Therefore, many people choose to give up active treatment under the pressure of reality.

In other words, only a few individuals from relatively well-off families or with high social status are sent to the hospital.

However, Fang Yan still intends to take over.

First of all, all these people were called over by Director Liao, so I have no reason to refuse.

Secondly, they are all veteran revolutionaries and comrades. If Fang Yan refuses treatment because of the possibility of failure, he himself will not be able to forgive himself. He should at least try treatment.

Third, although the current situation is quite complicated, it has not yet reached the point where it is incurable. At least in the past, there were many masters of traditional Chinese medicine who were experts in treating liver diseases, and there is a lot of experience that can be learned from.

Fang Yan began to examine Old Master Liu from four angles.

The liver was swollen about five fingers below the ribs. Besides the information in the documents, he also spoke in dialect:

"My lips have been feeling a bit numb lately, I wonder if that counts?"

"Yes!" Fang Yan nodded, then said:
"Open your mouth so I can see your tongue."

The old man opened his mouth, and Fang Yan stared intently at the appearance of Old Master Liu's tongue, his judgment of the illness becoming clearer.

His tongue was a dark red, like earth baked by the scorching sun, exuding a burning dryness, which is a typical manifestation of yin deficiency and internal heat.

With prolonged cirrhosis, liver yin is depleted, leading to internal heat, much like the firewood in a furnace is almost burned out, yet still retains a scorching residual heat.

The tongue coating is so thin that it is almost invisible, and in some places it has even peeled off to reveal a smooth tongue surface, like mottled peeling paint. In traditional Chinese medicine, this is called "peeling coating", which means that the spleen and stomach qi is extremely deficient and unable to transport and transform food and water to produce tongue coating.

The spleen and stomach are the "foundation of acquired constitution." Now that the foundation is shaken, it's like the soil in the field has become compacted, and even grass can't grow. It's clear that the old man's digestive function has long since declined, which explains his poor appetite and increasingly thin body.

Looking at the tongue, although there are no obvious dark purple spots, the edges of the tongue are faintly bluish-purple, and the red spots on the tip of the tongue are as fine as sand. This is a sign of yin deficiency and blood heat, and poor blood circulation.

The liver is responsible for storing blood. After cirrhosis, the liver vessels become blocked. In addition, the deficiency of yin and the excess of fire scorch the blood. It is like a river channel narrowing due to drought, and the water flow is also carrying fire. It is not smooth and easily damages the vessels. This can also explain why he experienced numbness in his lips. The deficiency of qi and blood and the lack of nourishment of the vessels mean that even the lips and tongue at the very end cannot be nourished.

Fang Yan looked away as he spoke:
"Please take my pulse."

The old man obediently did as instructed, while asking in dialect:

"Dr. Fang, how much longer do I have?"

Upon hearing this, Fang Yan feigned displeasure and said, "Look at what you're saying! It's just a liver swelling, but you're making it sound like a terminal illness. Are you looking down on my medical skills?"

The old man paused for a moment, then smiled and said:
"Hahaha... That was an oversight on my part!"

Fang Yan placed his fingertips on Old Master Liu's wrist pulse and could clearly feel that the pulse was thin, wiry, and rapid, like a taut thread with an imperceptible restlessness.

He didn't let go immediately; instead, he slowed his breathing and deliberately made his tone more relaxed.

“Your pulse looks weak, but it has a strong resilience. It’s like an old locust tree; the bark may be cracked and the branches sparse, but the roots are deep, and it can still sprout new buds in the spring.”

The old man raised an eyebrow, clearly not expecting him to say that, and the wrinkles at the corners of his mouth relaxed slightly.
"Oh? This old bone of mine can still be an old locust tree?"

"Why not?" Fang Yan withdrew her finger, smoothed his cuffs, pointed to his right hand, and said:
"Think about it, we didn't collapse during the snow-capped mountains and grasslands, even amidst gunfire. What is this liver problem compared to those tough battles?" He changed the subject, his eyes becoming sincere. "Illness is something you have to be afraid of first. If you think you can't get through it, it will dare to push its luck; but if you think, 'I can hold on for a few more years and see my children live a good life,' it won't be so arrogant."

Grandpa Liu was silent for a moment, then gripped the armrest of his wheelchair tighter, showing that he was not calm. However, remembering the dialect that Director Liao had recommended, he still trusted the man to some extent.

Seeing that Fang Yan's eyes were calm and he didn't seem to be lying, he smiled and said:

"Dr. Fang speaks just like my instructor back in the day, always saying encouraging things... haha..." He said this, but the melancholy in his eyes had dissipated considerably.

But turning his head, he touched his stomach and said:

"However... my stomach is really bloated, I can't lie flat at night, and sometimes I feel like I'm going to collapse..."

“Bloating is because the water hasn’t drained out, and being unable to lie flat is because of stagnant Qi. These can all be regulated.” Fang Yan took over the conversation, her tone firm. “It’s like a clogged water pipe at home. You have to clear it first, you can’t rush it. You, don’t think about anything right now. Just be like an old locust tree, bask in the sun every day, listen to some music, take your medicine on time… Leave the rest to me.”

He paused, then added, "Back when you were fighting, didn't you also adhere to the principle of 'strategically despising the enemy while tactically respecting them'? It's the same when you're recovering from an illness. You have to relax and think that this illness isn't a big deal; but you also have to listen to the rules when it's time to take your medicine and rest. If we work together well, not only will you feel more comfortable, but you might even be able to walk a few steps on your own with a cane after a while."

The old man laughed out loud at his words, his laughter slightly breathless, but much clearer than before:
"You little rascal, Dr. Fang, are you just trying to make empty promises to me?"

Fang Yan said with a smile:

"Hey, I didn't make any empty promises. Have you seen anyone say I can't cure this disease?"

That makes perfect sense. Whether Fang Yan was just lucky or he was truly exceptionally skilled, it's now a widely acknowledged fact. All his achievements are verifiable, and most of the newly built factories around the capital are thanks to Fang Yan.

Thinking of this, Old Master Liu said:
"Okay, I'll trust you this once. If you can really walk a few steps on your own, I'll treat you to my family's braised pork."

"I'll remember that." Fang Yan smiled. "But you have to watch what you eat for now. Once you're feeling better, we can discuss anything, from braised pork to just a couple of drinks."

As they spoke, Fang Yan released the old man's right hand.

He already knew what was going on.

The old man's tongue was dark red with fine red spots on the tip, and his pulse was rapid and restless, which was clear evidence that the heat toxin had penetrated deep into his blood.

Just like a spark hidden in an old pile of firewood, seemingly insignificant, but slowly igniting a smoldering fire, this heat toxin is not formed in a day or two. With long-term cirrhosis, the liver meridians become blocked, and the flow of qi and blood is obstructed. Over time, this accumulates and transforms into heat. The heat then scorches the blood, making the blockage even worse, forming a dead knot of "heat toxin wrapped in blood stasis".

Numbness of the lips and bluish discoloration of the tongue are signs that heat toxins have depleted yin and blood, and that the meridians are not properly nourished. It's like a vine that has been dried out by fire, where even the tips have lost their resilience.

A liver swelling five fingers below the ribs that feels hard to the touch is called "zhengji" in traditional Chinese medicine. It is the result of blood stasis stagnating for a long time and forming a mass.

The liver is the place where blood is stored, but now it is occupied by blood stasis, like a huge rock piled up in a riverbed. Blood flow is obstructed, and portal hypertension results from this. A thin and wiry pulse is a reaction to the obstruction of liver meridians and the stagnation of qi. The wiry pulse, like a bow, suggests that there is a stagnant force in the body that can neither break through the blockage nor stop the body's vital energy from being depleted.

The formation of ascites appears to be due to internal retention of dampness, but it is actually closely related to blood stasis.

The "Essential Prescriptions of the Golden Chamber" states that "when blood is not flowing smoothly, it becomes water." When the liver meridians are blocked, the flow of qi and blood becomes abnormal, and body fluids cannot be distributed normally, so they accumulate in the abdominal cavity and become ascites.

However, this dampness is not simply "cold water," but "turbid water" that has been scorched by the heat toxins in the blood. So, while the old man was suffering from abdominal distension, he also had a dry mouth and peeling tongue coating. It was like a saline-alkali land that looked watery on the surface, but the soil underneath had already been scorched. It lacked body fluids and could not expel the turbid water, making the contradiction between deficiency and excess particularly prominent.

The old man is advanced in years, and his spleen and stomach qi have declined (the peeling of the tongue coating is clear evidence of this). His liver and kidney yin fluids have been depleted by heat toxins (his tongue is dry and red, and his pulse is thin). Just like the roots of an old tree that have long since withered, he can hardly withstand the wind and rain.

At this point, if one uses strong medicine to attack the blood stasis and promote diuresis, it is like chopping branches off an old locust tree with an axe. Although it can temporarily remove some of the excess, it will damage the already weak foundation. However, if one only replenishes the deficiency without eliminating the pathogens, the blood stasis and ascites will continue to deplete the body's vital energy, leading to a vicious cycle of "the more you replenish, the more stagnant it becomes, and the more stagnant it becomes, the more deficient it becomes."

He remained outwardly calm, but his mind was racing, trying to figure out how to prescribe medication in this situation.

PS: After finishing this chapter, I still owe everyone 14000 words.

That's all for today, please come early tomorrow.

(End of this chapter)